Laserfiche WebLink
M <br />El <br />UST SYSTEM ®FIT OR REPAIR <br />(Submit minimum of 2 sets of plans & apprkations as originals will be retained by EHD) <br />1. Site map enclosed YES [ ] NO [I <br />2 Manufacturer's spec sheets attached for all equipment to be installed YES [ ] NO [ ] <br />3. Description of work to be completed (if addiri-a pVM UDC's, or other UST equipment or performing tank top upgrade, <br />use the UST Installation Application_ -8 as necessary for a timely plan review), <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />A <br />5. All equipment is State certified or approved. YES [] NO [I <br />9-M 75, 77,7711 <br />a. vVill piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address City 7-jp <br />11 ✓ •:- -r:•• 9 • r= -•9 7F, = <br />r. .:i• <br />d. Describe how nnsale materiat will be stored onsite prior to mariffesting oftile <br />e. Riniate Hauler and pernifted Treatment; Storage & Disposal Facility. <br />Hauler Name • •.: <br />Address city rip - <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone <br />Address. <br />City 7-rA <br />Hatter Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone �) <br />Address City zip <br />- <br />EPA W# (itmnsporlied to a permitted TSD fatality) <br />8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [I <br />9. Describe, in detail, how the sod and/or water sample(s) b,eneath the piping or dispenser will be obtained: <br />10. Hamiling Of 43=waled sod (Contaminabed-Soll Hazardous Wage H <br />Name Hauler tion # Phone (.. } <br />Address City zip <br />b) If sofi is not to be hauled, describe what win be done with it: <br />2 <br />